Tennis Elbow

I’m sure we have all heard the term “tennis elbow” before. Especially with the US Open wrapping up this past weekend. Tennis elbow is the common term for “lateral epicondylitis,” which is inflammation of the lateral epicondyle of the elbow.

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What is Epicondylitis?

Epicondylitis is inflammation of the elbow where the wrist extensor muscles attach. Excessive use of the muscles (especially with performing back hands) will pull on the tendon and create inflammation and pain. Patients will then start to notice pain with any activity that uses that hand like lifting and shaking someones hand. That is usually why the pain persists so long with this injury. It’s hard to not use your hand. Every time you do, it’s like poking a bruise that you can’t see. You activate the muscles, the muscle pulls on its attachment to the elbow, and you create more inflammation in the tendon. 

Certain other activities and positions can also cause pain. Patients will commonly complain of pain with sleeping or when they first get up in the morning. The reason being, when we sleep our wrist is usually in a bent position. That position will put an extra stretch on the muscle and tendon as we sleep. That constant tugging of the tendon will lead to more inflammation and pain. 

Could it be Nerve Pain?

What a great question! The answer is yes. Your radial nerve runs right next to the lateral epicondyle. 

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Sometimes when the nerve is irritated it can present as “tennis elbow.” Typically if your nerve is involved you will get more tingling or pain into the hand as well as in the elbow. It’s always a good idea to double check though to be sure the true cause of your pain isn’t missed. 

How do I Make it Better?

If you get pain with sleeping the best thing to do is wear a splint at night. I recommend this to all my patients because it allows your injury to heal while you are sleeping rather than get worse. A resting splint at night is all you should need. It is irritating to wear at first but worth it in the end. 

If you are getting pain due to your radial nerve being irritated you want to perform this exercise.

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It will help to add length and mobility to the nerve. That should help to calm the pain sensitivity down and allow you to do more with your hand. Do two sets of 10 repetitions, through a pain free range of motion, twice a day. 

If you have true epicondylitis you want to increase the strength and flexibility of the tissue. Perform these three exercises, twice daily, to increase your wrist extensor strength and flexibility. That will help to strengthen the tissue, decrease the inflammation, and allow you to get back to your Serena-esk back hand pain free.

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Racquet Fit:

One final point about tennis elbow. If you get pain when you are playing tennis but don’t get pain otherwise, it’s a possibility your racquet is not fit to you correctly. Simple things like racquet weight, and grip size can have an effect on pain in your elbow. It’s always a good idea to make sure someone fits you properly to allow you to play as much as you can without pain. 

Conclusion:

I hope this helps answer why you might have elbow pain and what you should do about it. If you have any questions don’t hesitate to contact me. Thank you for reading!






Welcome to our new PT, Paul Rodrigues

We are happy to extend a warm welcome our new physical therapist, Paul Rodrigues. Paul will be seeing patients in our North Kingstown, RI location at 7610 Post Road.

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Paul received his Bachelor’s degree in Health Sciences in 2017 and his Doctorate of Physical Therapy from American International College in 2019. Paul completed clinical rotations in the outpatient orthopedic and has worked with athletes, post-surgical patients, and the geriatric population. He has been a member of the American Physical Therapy Association since 2016. He was a member of the American International College soccer team and enjoys staying active and working out during his free time. He constantly takes opportunities to further his education and understanding of pain and rehab by reading current evidence. Paul is passionate about empowering his patients helping them reach their goals.

Schedule your appointment with Paul today!

Benefits of the Romanian Deadlift for Golfers

If you are a golfer and you only have time for one exercise (or you just don’t like working out), the Romanian Deadlift (RDL) is by far my favorite. I work with a large variety of golfers, from young to old, scratch to high handicap, and no matter skill or age, everyone can benefit from some RDLs. 

What the Heck is an RDL?

So I guess before we talk about why I love RDL’s, you should know what the heck I’m talking about. RDL’s originated from olympic lifting as a way to strengthen your back and legs in one movement to help improve the clean and snatch movements. It is a combination of a straight leg deadlift, and a traditional deadlift. 

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It focuses on strengthening your spine, abdominal muscles, and your hip/leg muscles all in one movement. Now who doesn’t love that?! 

If you are intimidated to start a new exercise that you have never done before, don’t worry. I prepared a video that will get you started on how to perform the RDL in a safe manner that won’t get you injured (it’s kinda my thing).

Why do RDLs Help My Golf Swing?

If you are going to have a good golf swing you need good posture. Not only do you need good posture, you have to be able to maintain that position throughout your golf swing. Look at every pro golfer, man or women, they have a perfect setup position. They are also able to stay there through their backswing and follow through. 

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Look at Ben Hogan in this picture (arguably one of the best swings in the history of the sport). He is able to keep his back on that line throughout the swing. That will improve consistency, and power, because nothing is being wasted with unnecessary movement in the swing (It’s physics, trust me). If you want to be able to do this you better have strong abdominal and hip muscles, hence the RDL. 



Posture Sounds Cool but what about POWER!



I get it, no one brags to their friends about how good their posture is. They always brag about how far they can hit the golf ball. The great thing about the RDL is that it can easily be a starting point to build some power. Once you have the movement down, you can start to load it with weight. That will build strength. Once you have a base level of strength you can start to do some “swings” which will build power in the golf swing (now I have your attention). If you have never done a swing here is a good video on how to perform one properly.

I hope you enjoy the new exercise and the savings in time. If you have any questions don’t hesitate to contact me. As always, thanks for reading.

Do I have Hip Bursitis or Back Pain?

It’s a common story that I hear in the clinic, and a frustrating one. A patient complains of prolonged lateral hip pain (outside pocket area) that came out of nowhere. They went to see their doctor and the doctor says “Congratulations, it’s a boy!” Just kidding, they take an x-ray which comes back negative (good thing) and then say “You have hip bursitis. Let’s give you some cortisone and send you on your way.” The only problem is that your hip doesn’t improve and you are left frustrated, questioning “Why?” The answer is, you probably don’t have hip bursitis, you probably have a back problem. Allow me to explain further. 

What’s Hip Bursitis?

Hip bursitis is an inflammation of the bursa sac on the outside part of your hip. Its job is to keep your muscles and tendons from rubbing on your greater trochanter and damaging them. Bursitis happens when the bursa sac gets compressed and inflamed which will cause pain in the area.

Most of the time the pain is due to activity and will improve if you rest. The patients that I see are the exact opposite. They hip hurts when they rest and will feel better with certain movements. If that is the case then you probably don’t have true hip bursitis. 

If I Don’t Have Bursitis Then What Do I Have?

Let me introduce you to my friends dermatomes and myotomes. These little characters are areas of the body that are innervated by our back. They tell our brain what we feel (myotome) and how we move that area (dermatome). 

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If you can’t tell from the pictures there are two different areas of the spine that innervate the lateral hip where you might be having pain. Let’s look at the dermatome on the left first. You can see the two blue circles around where the L2 spinal segment innervates the skin. As you can see it starts up high by the hip and travels down the thigh. If your back is causing your “hip pain” you will have irritation all along that pattern. Simply take a fork and lightly press it into your skin and compare your irritated side to your non-irritated side. If your irritated side is way worse, or you don’t feel anything at all, your pain is probably coming from your back. 

Now let’s take a peek at the myotome pattern in the picture on the right. You can see in that blue circle that your L5 controls hip abduction (move your foot out to the side), and external rotation (clam shell exercise). Both those movements might cause pain in a patient with hip bursitis so that doesn’t tell us anything. If you have issues coming from your back we can test other movements though. Hip extension (bridges), knee flexion (hamstring curl), and ankle dorsiflexion (bring your foot up) are all partially controlled by L5 as well. If you test the strength in those movements, and they are weak as well, guess what, its coming from your back not your hip. 

Why Do You Hate My Doctor?

I started this post talking about a problem that I see all the time. It’s true that doctors miss a lot when it comes to orthopedic problems, but it’s not their fault. Most general practitioners are not educated enough in ortho. Most Ortho docs are too busy to try to tease things out. I don’t hate any of them. Heck, some PTs miss this stuff too (I know I did when I was just starting out). I just want to educate you so if you are having a similar issue you can be an advocate for yourself. So if you are someone who has been dealing with hip pain for a while that hasn’t gotten better, it’s time to think outside the box. If you run yourself through these tests and start to get some positive results, stop working on your hip, and start working on your back. 

I hope this helps you if you are having hip pain that hasn’t improved. If you have any questions please contact me here at OrthoCore Physical Therapy. Thanks for reading!




How I Used Dry Needling to Fix My Neck Pain

Unfortunately...even I get neck pain. I know what you’re thinking. That would be like Superman getting a head cold. It’s not supposed to happen. Well, I’m sure that even Superman is subject to the occasional sinus infection. But, luckily for me, I have access to excellent treatment and know what to do when my neck goes on the fritz. Let me show you how I use dry needling to fix my neck pain.

I’ve dealt with neck pain off and on for a majority of my life. When I was younger I would get chiropractic adjustments to help. Nothing against what a chiropractor does, but I have not needed a single adjustment since being introduced to dry needling in 2010. I was at a conference and my neck went out one morning. To anyone reading this that has had neck pain in the past you know exactly what I’m talking about. I could not turn my head at all to the right and when I did try the pain would shoot down to my shoulder blade and up into the back of my skull. It was horrible. Oddly enough I had met someone at this conference that was certified in dry needling and also giving a talk on the technique and how it can help with all types of pain and restrictions. When he saw how much pain I was in at breakfast he offered to treat me. Now, truth be told, I am not a fan of needles at all (I know, ironic). I was willing to put my fears aside due to the intense pain in my neck and give dry needling a try. Thank god I did, because within 15 minutes I had almost 100% motion back, and no pain. I was hooked, and within a couple of months I was certified myself to help others quickly recover from pains and strains.

Fast forward to last week. I woke up, stretched my arms up like I do every morning and BANG! Searing neck pain. My first thought was, WTH, am I that old? My second thought was, yes. My third though was, I need to get to work and have someone dry needle this so I can function and help my patients.

When I got to work I had similar symptoms to 2010. No neck rotation to the right, getting pain from my shoulder to my neck, and also getting some symptoms down my arm. Even though she was super busy, Kristen agreed to help me (did she really have a choice?). After a dry needling treatment to my C7 and upper trap I was 90% better. The pain was still there slightly and my motion was improved enough to where I could work without any restriction. I then did some exercises to open up my cervical facet joints to take care of that last 10% of my recovery.

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The moral of the story is, we’re all older than we think we are. Okay not really. The moral is that if you are dealing with pain you don’t have to. Think about giving dry needling a try, even if you are skeptical or afraid of needles. You will be pleasantly surprised by how effective it is and how much better you feel after just one treatment.

Interesting in dry needling? Call and make an appointment here at OrthoCore Physical Therapy to see how it can help YOU!



How to Increase Hip Mobility for Golf

The PGA season has begun and, if you’re anything like me, those golf juices are flowing! It has been at least two months since I have swung a golf club (thanks polar vortex). The off season is great for recovery but it’s also a great excuse to get lazy with your fitness program. It’s very easy to get stiff over the colder months because we don’t move as much. This stiffness can rob your golf swing of consistency and power. The biggest area of your body that is responsible for power in your golf swing is your hips. So let’s get those joints moving and get this season rolling!

When you swing a golf club your hips/pelvis to internally and externally rotate about 60 degrees in each direction. As a golfer, when you go to the top of your backswing you need internal rotation of your trail hip, and external rotation of your lead hip. In your downswing you reverse those movements. A restriction in either hip, in either movement, can lead to swing faults. No matter what the fault may be, it will definitely lead to inconsistencies in your golf swing.

Another problem with poor hip mobility is a guaranteed loss of power and distance. If you want to be able to hit the ball a far way you have to be able to spin fast. When we start our downswing we actually push down into the ground with our feet. The earth is just a little bit larger and stronger than us so it pushes back and creates what is called ground reaction force (hello physics!). Now before I lose you in all my golf swing dork talk let me simplify things. For 99% of the world, our legs are the strongest part of our body (not this guy, do you even leg day bro?).

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When we push into the ground, all that energy that is created gets pushed up the legs towards our abdominals. The pelvis turns that energy into torque. The more torque that is created, the faster we spin, and the harder we hit the ball. If we have a restriction in how much our hips and pelvis can twist we can’t create as much torque and we don’t hit the ball as far as we possibly can. Make sense?

Now that I have completely confused you with talk of physics, torque, power, blah, blah, blah let me just tell you what to do about it. Here is my favorite hip mobility exercise for golf. You can perform this stretch multiple times a day. Just be careful if you have any pain in your hips and/or in your knees. If you are consistent with performing this stretch, your mobility will increase, and you will be hitting that ball farther down the fairways before you know it.

If you have any questions please don’t hesitate to contact us here at OrthoCore. Enjoy the last month of the off season and use it to get your body ready for the upcoming season.



Retiring From Powerlifting By Adam Davis (OR: How I learned to Stop Lifting Heavy and Love the Lunge)

I’ve rewritten this blog multiple times now. Originally I was just going to talk about lunges. A client of mine who’s a former trainer herself sent me an article regarding the common mistakes when both practicing and coaching lunges. This article upset me because it challenged how I’ve been coaching this movement for 6 years professionally. It was written by one of our favorite professionals in the industry to boot (Dr. John Rusin). I was forced to open my mind and accept new information. And for the first time since joining the OrthoCore Physical Therapy team, I told my clients I was teaching something wrong (well more like less efficient, we’ll say).

Now where am I going with all of this? Well first off, as a coach I have a policy that I never teach something that I don’t practice on my own, unless a client really needs something unique in their programming. I begrudgingly started to practice these new lunges. I’ve had a long love hate relationship with lunges since the first day I worked out my legs. I know their importance and the importance of unilateral work in general. But lunges suck. Or rather I sucked at lunges. So I avoided doing them for a long time during my powerlifting career. I wanted to focus on competition lifts like squats and deadlifts. Those were fun, short, and heavy sets that felt impressive. Lunges were long, grueling, and boring exercises that burned and used light weight. Not something a 23 year old powerlifter was excited to do.

Well now I’m 30 and have 3 notable prior sports injuries, arthritis of varying degrees in many joints, and a stability issue in my right hip. That issue is likely from years of ignoring lunges I’d wager. Well upon practicing these new lunges that better utilize the mechanics of the hip, I became more aware of this instability, as well as generally had better feedback from it. I had more control than ever before in this exercise when working on that right leg, and despite the muscles being stronger, it felt harder. My rotator cuff was working in ways it wasn’t before (yes your hips have a rotator cuff too).

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This newfound sensation with an old exercise blew my mind. How had I not come across this information on how to perform lunges in 6 years of training and 5 years of competitive lifting? My lower body program shifted to primarily focus on lunges first, and I began to go from heavy weight to lighter weight/higher reps. Now I perform them with unevenly loaded dumbbells to both challenge stability and engage the glutes even more than the original modification did. Compound movements like squats and deadlifts became ancillary lifts in my routine.

Ok so let’s get to the real point here. Ever since my shoulder injury 4 years ago, I’ve been out of the competitive lifting scene. It’s been somewhat of a rough journey as I was just months away from my first major competition (everything I had done before were unofficial amatuer meets that were a bit more loosely regulated). That really messed with me. I went through ups and downs trying to get back to the numbers I used to put up before that injury, never quite making it in any of the competition lifts. I even went through a period of depression because of it and gained a lot of weight.

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The last 2 or so years I’ve been getting back into consistent training and leaned out to a nice healthy level again. But I’ve still always been training for strength overall. So “going heavy” was my priority in a lot of lifts, even if I was sure to do things like care for my shoulder health and isolate where needed. I even got my bench press up to 235 lbs after rehabbing my left shoulder from an impingement! But even though I’m mechanically stronger than I used to be in my powerlifting days (I move weight more efficiently), the fact that the actual amount of weight I was lifting was so much lower continued to nag at me. That was until the last few months.

I’ve recently come to terms with the fact that I will never compete again, at least not in any ranked league, and even if I compete in an amateur meet again I know I will be far outclassed. I had instead been focusing on my clients’ programs, and exploring new avenues like yoga. I specialize in corrective exercise and movement after all, why not broaden my own training to include more avenues regarding it? And although I was initially hesitant to admit there was information that contradicted what I coached, these lunges were my final step to finding where I really need to be training wise for my body at my age.

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Let’s wrap this up as I tend to ramble when talking about my own experiences. Focusing on these lunges first basically meant a lot of my strength and energy would be sapped for the big lifts. So I did what powerlifters swear never to do. I lifted lighter weight. My squats were endurance and mobility focused sets of 10-15 reps. My deadlifts stayed at low rep sets of 3-5 (I personally believe the conventional deadlift is risky for high reps), but the weight I used was relegated to weight that was normally not a 3-5 rep max. I also started to superset multiple types of deadlifts, so it was more like one set of 6-10 when combined, again helping my muscular endurance more than my usual training used to.

And you know what? I’m seeing tons of progress. My hip feels stronger every week. I’m still adding weight to my lifts even if I use less weight overall compared to even a couple of years ago, nevermind my powerlifting days. My shoulder mobility is more consistent, and my core imbalance is improving faster. To top it off, despite lifting so much lighter, I have more muscle mass on my body now than ever before, which helps keep my metabolism well regulated so I stay leaner easier, and cushions my poor arthritic joints.

So after 4 years of frustratingly chasing the dragon of reaching my former glory days. I’ve finally accepted that I’m not living those days anymore. I’ve retired from heavy weight you could say. I still challenge myself, but in ways that are more appropriate for my body given my history and needs. And you know what? I’m happy with my programming, performance, and body for the first time in nearly 5 years. The new year just started, so I guess this is my “new me”. Perhaps something as simple as reexamining your training programming needs is all you need for a “new you” as well. If you’d like to try and don’t know where to start you can always contact me. Otherwise I wish you all luck in your endeavours in health and wellness in this new year. And remember, it’s ok to be a different kind of athlete than you were last year.

~Adam




Hip PNF Kicks

Outside of your core muscles, the hips are probably the most important muscle group in the golf swing. They help your hips to twist and also transfer all of your leg strength up into the trunk muscles. It’s that energy transfer that helps to send that little white ball farther down the fairway. Most golfers who workout do work on their hip strength. The unfortunate part is that most are going about it all the wrong way.

The hip joint is a very dynamic joint. It is a ball and socket joint just like the shoulder.

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The great thing about the hip joint is that it can move in almost any plane due to its kinematics (scrabble word, 800pts). That allows for all the movements that happen during the golf swing. Most people think there is just a twist at the hip. The truth is there is a natural twist, squat, and lateral shift happening at the same time in the golf swing. If it happens during the golf swing why wouldn’t you train that way?

When most golfers hit the gym they might do squats/deadlifts, and some lateral walk or side lunge. Awesome! I’m not saying those are bad to do. I certainly do them when I go to the gym. What I think is important is to incorporate all the movements of the hip joint into one exercise. That way when you make a golf swing your body has been trained to moving through all those planes of movement and can transfer that energy more efficiently. That will equal more power into the golf ball, and hopefully a lot more distance.

So I’ve teased you enough. You are probably saying at this point “what exercise does all this at once? That sounds like an infomercial.” PNF (Proprioceptive Neuromuscular Facilitation) patterns are the way to go. They are simple patterns that move the hip through all the ranges of movement in one movement. Here is a quick video that will show you how to go through the patterns on your own.


I prefer that clients do it without holding on if they can. That way you are working on balance as well which is also very important in the golf swing. I also will have people start with moving slow so you have to own the movement. Once that gets easy add some speed to it. Just don’t move so fast that you start to lose your balance and fall over. If you can’t do it with the resistance band at first that is okay. Just work on the patterns without resistance until it gets easy.  

You will definitely feel the burn in your hips when you do these exercises (take that Jane Fonda). Work on this over the off season and see how much farther you hit that golf ball once winter is over.

OrthoCore Physical Therapy has convenient locations in Westerly and North Kingstown, RI. For more information on our services please call (401) 667-0131






Balance with Pitching

Balance and posture were the first two mechanical flaws I was taught to look for when I became certified through the National Pitching Association (NPA). The NPA is a group that was founded by Tom House who is the throwing coach for the G.O.A.T. (Tom Brady for those who live outside of New England), Drew Brees, Randy Johnson, Nolan Ryan, and so many other top athletes that this blog post would be 18 pages in just names alone. Their mission is to focus on strength and conditioning techniques that enhance a players skills and reduce their risk of injuries. In short, they look at the body first and performance second. You can’t be a division 1 pitcher if you can’t stay on the mound. Balance and posture is so important to this group that they don’t even look at anything else until this mechanic is fixed.

When we talk about balance we aren’t talking about a pitchers ability to stand on their drive leg for a long period of time. Quite honestly that doesn’t even matter that much. What we’re looking for is the pitchers ability to keep their shoulders level, through their stride, and delivery of the baseball to home plate. Any deviation from this level position will lead to a compensation which can lead to arm injury and break down over time.

Here are a couple of examples of good posture through delivery.

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Here are some examples of bad posture through delivery. They most common coaching mistake we see is telling a player to “get on top” of the ball.

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Now some of you reading at this point might be thinking, “Hey Matt Harvey was a dominant pitcher and Okajima was an World Series winning All Star.” That is all true but how long were they dominant and, at what cost.

A players inability to maintain their balance and posture through the delivery can be caused by a multitude of reasons. Literally any restriction in anything from the ankle up to the trunk can cause a loss of posture in the players delivery. I always recommend that a player get screened by a qualified movement specialist to be sure you are attacking the correct strength and flexibility deficits that are causing the problem. That being said here are some of the most common causes of loss of posture that I see with my pitchers.

Flexibility:

If a players hips and trunk are tight it will limit their ability to rotate which can lead to a loss of posture while throwing. Here are two simple stretches that you can do to help improve your hip and trunk mobility. If you try to do these exercises, and its really easy, then flexibility probably isn’t the reason behind why you are losing posture. It’s still a good idea to perform them regularly to maintain the flexibility that you have. Try doing 15 repetitions holding each repetition for about 3 seconds

Hip IR/ER with Twist:

Sit on the ground with a bat. Rotate one leg in and the other leg out keeping a 90deg bend in the knees. Once your legs are touching the ground rotate your arms towards the leg that is rotating in.

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Open Book:

Lie on your side with both legs bent up to 90deg. Rotate your arms open like a book.

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Core Strength:

Your core muscles are what keep your trunk upright while you are twisting as you throw. They also help to transfer the energy from your legs up to your arm. That means that by doing this exercise not only will you be able to better maintain your posture, you will also be able to throw harder (and who doesn’t like that). Perform 15 repetitions on each side and hold this reach/kick position for 3 seconds.

Plank with Reach:

Get into a tall plank position focusing on squeezing your glutes and keeping your core tight. Stay stiff and alternate reaching with your hands out in front of you. It’s important to prevent your hips from twisting while you reach.

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Plank with Kick:

Get into the same tall plank position. Alternate kicking a leg up in the air. Make sure that your hips don’t twist. Also make sure that your back doesn’t arch as you kick up.

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Balance:

Well it’s what we’ve been talking about the whole time. Didn’t you think I was going to give you an exercise to work on? Balance is important in your trail leg but also your landing leg so be sure to work on this on both legs. You may notice a difference between your legs which is completely normal. The more you work on it, the more your legs will equal out. Try to do 15-20 repetitions on each leg.

Single Leg RDL:

Stand on one leg. Keeping your back straight, balance on one leg and kick the other leg back. The goal is to get your body parallel to the ground without rounding you back. This is a really challenging exercise so don’t get frustrated if you have trouble with it. Just keep practicing and eventually you will master it.

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I hope this helps you improve your strength and flexibility to limit any loss of balance and posture that you might have in your delivery. If you haven any questions or problems please don’t hesitate to contact me on our website, www.orthocorept.com , or via email, IanM@orthocorept.com.

Making Time for Physical Therapy

Let’s face it, nobody has enough time anymore. It’s the number one reason that we hear from our patients as to why it takes them so long to get started on a rehabilitation program. Once people do start on a program, they finally commit to getting better. The thing that makes us crazy, though, is when people throw all of their hard work away by not sticking with their program once they are discharged. Why do patients fall off the wagon once they are done with treatment? Time, not enough time.

We’re here to offer some solutions for people who are looking to stay on top of their program and stay pain-free especially during this busy holiday season.

1. You don't have to do every single exercise, every single day.

Rehabbing from an injury is a huge commitment. You usually have to go to PT 1-2x/week for about an hour per visit. When you are not at PT you have "homework" that you are supposed to do at least once per day. It all starts to add up. Patients think that once they are discharged they need to keep up with the pace of doing everything once a day. Add that to everything else that people have to do during the day and it starts to get overwhelming

We always try to educate our patients that rehabilitating is different from maintaining. When a patient is rehabilitating, they are working on correcting whatever strength, flexibility, or motor pattern issues that are leading to their pain. It takes more repetitions to make those changes, and that’s why we usually ask the patient to perform their program daily. 

Once they make those changes and are now pain free, the patient transitions to the maintenance phase. During the maintenance phase patients only have to perform the exercises 1-2 times/week. What a relief! Think of all that extra time you will have on your hands. 1-2 times/week is all that is needed to maintain that new strength and flexibility you have worked so hard to obtain. 

2. You don’t have to do all the exercises at once. 

Most patients’ rehabilitation "homework" consists of at least 5-6 exercises that you are supposed to do multiple repetitions of. That can add up to a lot of time in one sitting. Instead of trying to carve out a block of time to perform the whole program you can do each exercise at least once per day. If you have a free couple of minutes, do one of the exercises. If your program consists of some exercises that have you lying down you have two opportunities during the day where you start and end in that position (yes, we’re talking about sleeping, people!). Take a little extra time to do those exercises when you are already in the starting position. That way you can get to the whole program throughout the day, rather than feeling like you need "extra" time to perform the whole thing at once. 

3. You probably don't have to do every exercise on your program for the rest of your life. 

If you feel like your program is really extensive by the end of your rehabilitation, you are probably correct. If you truly feel like you can't do every exercise then be honest with your therapist. We always try to work our programs around what the patient is willing to commit to. Sometimes that is only two exercises. If that is all you can commit to, it just means you have commitment issues and that’s fine (…or is it?). In all seriousness, we would rather give someone a couple of exercises that will highlight the biggest areas of dysfunction vs. a program that is aimed at fixing everything that they won't stick to.

4. Pain sucks, so why would you want it to come back?

It drives us CRAZY when patients come back with the same injury. This drives us up a wall because the typical answer as to why their pain returned is because they didn't stick with the program. It’s like failing a test that you have the answers to. 

One of the best ways that we've found to keep people on track is setting a schedule. Set reminders on your phone, place sticky notes around your house, whatever reminders you need to stick to the schedule. That will give you the best opportunity to stay on track and live pain free!